Symptoms
Classic symptoms of tremors include rhythmic shaking of the head, hands, legs, or trunk Table 01. Rhythmic shaking often results in loss of manual dexterity or clumsiness. Voice tremors give speech a shaky, quivering quality. Other symptoms include slow voluntary movements and unsteadiness or shaking legs while standing.
Tremors are categorized according to their symptoms Table 02. Tremors vary according to their speed, severity, frequency, and whether they occur while resting or during directed movement. Substances such as caffeine may exacerbate postural tremors.
Table 1. Characteristics of Tremors
Slow, rhythmic movements involving the fingers, hands, arms, legs, head, or trunk. Onset of early adulthood, but occasionally later adulthood. Quivering or shaky voice Difficulty writing or handling utensils Symptoms occur only at rest and stop during movement, or only during movement and stop at rest Symptoms become milder or disappear after consuming alcohol Symptoms exacerbated by stressful situations, such as before speaking in front of a crowd Table 2. Tremor Classifications
Enhanced physiologic tremor Essential tremor Intention tremor Rest tremor Fine tremors with a frequency of 8 to 12 HzOccurs during movement or when holding a fixed position (postural tremor)Does not normally produce symptomsMovement may not be apparent until it is exaggerated by anxiety, coffee consumption, hyperthyroidism, or drugs such as lithium and tricyclic antidepressantsAmplitude and frequency vary among different people and within same person at different times Occurs on both sides of bodyOccurs during movement or when holding a fixed position (postural tremor)Often involves the head and voice, and can involve the hands, legs, or trunk.Can occur in the absence of stimuliApproximately half are inherited, and half are sporadicConsumption of alcohol can reduce these tremorsTremors are most noticeable when head or hands are held outstretched against gravity, and least prominent at restTremors can be exacerbated by tasks requiring precision, such as writing Large, irregular, and slow tremors of 2-4 HzOccur when person makes a purposeful motionCan be caused by damage to the cerebellum Usually associated with Parkinson's diseaseTremor in a relaxed, supported limb, usually beginning in the fingers and later involving the arms and legsInvolves a characteristic ?pill-rolling? movementParkinsonian tremor is slow, approximately 3-8 Hz, and can be suppressed by voluntary movement Risk Factors
Having a family history of tremor puts you at risk for developing a tremor yourself. Essential tremors can cluster in families, and when they do, are called familial tremors. Up to 50% of essential tremors are inherited disorders.
Certain underlying diseases cause tremor. Neurological diseases such as Parkinson's disease, multiple sclerosis, chronic alcoholism, cerebellar damage, or stroke can all cause tremor. Parkinson's disease is characterized by rest tremors, whereas multiple sclerosis, chronic alcoholism, stroke, and cerebellar damage cause intention tremors.
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I'm Beth Isaac, PharmD. Welcome to PDR Health!
